This is a guest blog by Aviva Aron-Dine, Vice President for Health Policy, the Center on Budget and Policy Priorities

Proposals to take Medicaid coverage away from people who don’t work or engage in work activities for a set number of hours each month will lead to large coverage losses, worse access to care, and less financial security, previous CBPP analyses showed. And they’re unlikely to advance their goal of increasing employment; in fact, they’ll likely make it harder for some people to work. Two new CBPP analyses (see here and here) show that, on top of these problems, these state proposals for waivers from federal Medicaid rules (some of which the Trump Administration has already approved) will have other, likely unintended, harmful consequences.

Many of those losing coverage will either be eligible people who lose Medicaid due to red tape or workers with unstable jobs who experience gaps in employment or can’t find enough hours of work every month.

Some eligible people will lose coverage due to complexity and state errors. The new Medicaid eligibility restrictions are extraordinarily complex for both states and enrollees, a new CBPP analysis explains. States will face an array of challenges to administer the new requirements correctly, such as tracking each enrollee’s compliance each month. And all enrollees, including those who are meeting the requirements, will have to jump through new hoops to stay covered. People who are working or engaged in work activities for a sufficient number of hours each month will have to understand which activities count toward the requirement, how many hours they must complete, and how to document their hours in these activities in accordance with state specifications. Enrollees who should qualify for exemptions will need to understand the exemption criteria, obtain and submit the needed documentation, and renew their exemptions periodically.

Experience with eligibility restrictions in Medicaid and work requirements in other federal programs shows that many eligible people will lose coverage. Certain vulnerable groups are particularly ill-equipped to cope with added red tape, which is why studies have found that people with physical disabilities, mental health needs, and substance use disorders are disproportionately likely to lose benefits, even though many should qualify for exemptions.

State errors will also cause some eligible people to lose coverage. Notably, two states with newly approved waivers, Kentucky and Arkansas, have struggled to implement other recent policy and system changes, causing tens of thousands of enrollees to lose coverage.

Working people will lose coverage because they can’t meet the work requirement every month. Most Medicaid enrollees work, but in unstable jobs in which hours fluctuate from month to month and in which an illness, family emergency, or disruption in child care or transportation can lead to job loss. As a result, nearly half (46 percent) of working low-income people who could be subject to Medicaid work requirements would face the risk of losing coverage under an 80-hour per-month standard, an earlier CBPP analysis found. Even among people working at least 1,000 hours per year (people meeting an 80-hour-per-month requirement on average), 1 in 4 would fall short at least one month during the year.

About 60 percent of Medicaid enrollees who could be subject to work requirements under Trump Administration guidance work at some point during the year, 15 percent report they couldn’t work due to illness or disability, and another 18 percent are caregivers or in school, the Kaiser Family Foundation estimates. With large shares of workers and people with serious health needs at risk of losing coverage, the majority of enrollees at risk likely fall into one of these groups.

These proposals will also have large costs for states, the federal government, and health care providers.

Implementing complex new eligibility restrictions will cost tens or hundreds of millions of dollars per state. States and the federal government will pay millions of dollars to information technology (IT) vendors and other contractors to change notices and forms to capture more information and reprogram eligibility systems to add and track new requirements. And states will have to hire staff to administer the new rules and monitor compliance.

As estimates from nine states implementing or considering such proposals show, projected costs are typically in the tens of millions of dollars per year, with even higher start-up costs for some states. Kentucky plans to spend $186 million in fiscal year 2018 and another $187 million in 2019 to implement its waiver. And a work requirement considered by Pennsylvania’s legislature would have cost $600 million and require 300 additional staff to administer, according to a state official. Effectively, these proposals divert some state and federal dollars from providing health care to creating new bureaucracy.

Coverage losses from eligibility restrictions will increase uncompensated care costs. As our other new analysis explains, work requirements and other barriers to coverage in Medicaid threaten to reverse the large drop in uncompensated care costs achieved as the Affordable Care Act (ACA) Medicaid expansion and other major coverage provisions took effect. Those costs fell by 30 percent nationwide as a share of hospital operating budgets between 2013 and 2015, with the largest drops in states experiencing the largest coverage gains: costs fell by an average of 47 percent in Medicaid expansion states. Reduced uncompensated care costs have benefited low-income families, who’ve seen large reductions in medical debt and, as a result, better access to credit. They’ve also benefited hospitals — especially rural hospitals — and other providers, as well as state budgets. Because new eligibility restrictions are projected to reverse a meaningful share of the coverage gains under the ACA’s Medicaid expansion, they will likely reverse a significant share of uncompensated care savings as well.

— Aviva Aron-Dine

]]>http://www.mlpp.org/proposed-medicaid-eligibility-restrictions-have-costly-unintended-consequences/feed0http://www.mlpp.org/proposed-medicaid-eligibility-restrictions-have-costly-unintended-consequencesGetting state priorities right by investing in children and familieshttp://feedproxy.google.com/~r/FactuallySpeaking/~3/Mik0KC-Eicc/getting-state-priorities-right-by-investing-in-children-and-families
http://www.mlpp.org/getting-state-priorities-right-by-investing-in-children-and-families#respondFri, 18 May 2018 13:17:33 +0000http://www.mlpp.org/?p=44286

With the reassurance that state revenues will grow slightly next year, state legislators will soon meet to iron out differences between the House and Senate spending plans for 2019. Decisions are expected to be made quickly, in part because it is an election year and both House and Senate members are eager to return to their districts to campaign. At the League, we hope that in their haste lawmakers don’t forget to make wise investments in the state’s children and families—many of whom have yet to recover fully from the great recession in Michigan and nationally.

Kids Count data show that despite lower unemployment rates statewide, for many families the only jobs available are low-wage and lack benefits, leaving parents struggling to make ends meet. The result has been stubbornly high rates of poverty, affecting one of every five children in the state, including more than 40% of African-American and 30% of Latinx children.

So what is the connection between the state budget and childhood poverty? It is through the allocation of state revenues—not campaign slogans—that lawmakers reveal their true priorities. By controlling the state’s purse strings, Michigan legislators have the power to change the odds for families struggling to find their way in the state’s shifting economy by investing in human capital, including health and human services, education, and early childhood education and care.

Poverty is itself a barrier to work. Parents who struggle to secure adequate food, clothing, shelter and transportation are less able to find and keep jobs—much less get the education and training they need to move forward and secure their children’s futures. Yet, state investments in public assistance programs that help stabilize families and ensure that children do not live in deep poverty have dropped dramatically.

One painfully blatant example is the state’s failure to increase income assistance grants for decades, along with the adoption of strict lifetime limits and other punitive policies for the Family Independence Program (FIP). The result has been a steep decline in the number of children receiving income assistance at the same time that child poverty remains high.

The governor recommended a very meager FIP grant increase of 1.2% for 2019, an increase that equates to $2 per person per month and leaves the maximum grant at only 29% of poverty. The House and Senate rejected even this tiny recognition of the continual erosion in purchasing power of state assistance, seemingly unaware that 80% of the beneficiaries are children, or not understanding that children won’t succeed if their parents can’t.

]]>http://www.mlpp.org/getting-state-priorities-right-by-investing-in-children-and-families/feed0http://www.mlpp.org/getting-state-priorities-right-by-investing-in-children-and-familiesLet’s talk sense about SNAP: The House bill would burden families and states with unnecessary paperworkhttp://feedproxy.google.com/~r/FactuallySpeaking/~3/drFv7DgKI0w/lets-talk-sense-about-snap-the-house-bill-would-burden-families-and-states-with-unnecessary-paperwork
http://www.mlpp.org/lets-talk-sense-about-snap-the-house-bill-would-burden-families-and-states-with-unnecessary-paperwork#respondWed, 16 May 2018 19:11:02 +0000http://www.mlpp.org/?p=44270

Many Americans say they hate government bureaucracy, excessive paperwork and unnecessary spending, but that is what some are pushing for in a vote that will likely take place in the U.S. House of Representatives tomorrow.

At issue are changes to the Supplemental Nutrition Assistance Program (SNAP), which provides food assistance to families and individuals with low incomes, most of whom are either working, looking for work or physically unable to work. SNAP must be reauthorized every five years, and reauthorization provides a time to make policy changes to the program as well as provide the next five years’ funding.

In an election year, telling voters one is going to “make people on Food Stamps* get up and go to work” can make for a good applause line, but it is based on bad policy and the faulty assumption that SNAP recipients do not work.

It would also increase the amount of paperwork families need to submit (and state workers need to process) to prove they do not have too much money in the bank and that their cars are not worth too much. Many states have reduced this paperwork and made the process more efficient, but the House bill would bring back a top-heavy, one-size-fits-all process for reporting assets. Reducing government bureaucracy, indeed!

It is not too late to call your member of Congress to urge them to oppose parts of this bill and to support amendments to improve the bill. Here is a brief outline of the things in the U.S. House bill that the Michigan League for Public policy opposes—and a couple of things we like:

New Work Requirements and Programs:

The League opposes the House bill’s requirement that all SNAP participants age 18-59 (not disabled or raising child under 6) to work and/or participate in a work program at least 20 hours per week, and to provide monthly documentation of that work.

The League opposes mandating states to set up new work programs to help households meet work requirements, which would cost a lot of money for states and likely duplicate existing programs.

The League opposes the implementation of any new work requirements or programs before Congress is given the results of demonstration projects (which are nearing completion and for which Congress appropriated $200 million in FY 2013) to test various approaches to employment services, work programs, and work requirements.

Asset Limit:

The League supports the House bill’s raising of the federal asset limit from $2,250 ($3,250 for households with elderly or disabled) to $7,000 ($12,000 elderly or disabled). Michigan has its own asset limit of $5,000 and would have to adopt the higher federal limit of $7,000 if it were enacted.

The League opposes the House bill’s reinstatement of a federal vehicle allowance and taking away states’ ability to establish a higher or more flexible allowance. Michigan has no vehicle value limit for household’s first vehicle and a value limit of $15,000 for the second vehicle, but the House committee bill would impose a $12,000 limit on all vehicles.

Categorical Eligibility:

The League opposes the House bill’s elimination of expanded categorical eligibility, which lets certain households who receive other assistance receive SNAP if their gross income is below 200% (instead of 130%) of poverty. According to CBPP, 20,000 households and 45,000 individuals in Michigan would lose SNAP eligibility if it were eliminated.

Child Support Enforcement:

The League opposes the House bill’s requirement that parents or guardians not living with the child’s other parent cooperate with child support enforcement in order to receive SNAP benefits. (It is currently a state option and Michigan is currently one of six states that takes this option.)

The League supports eliminating a state option to sanction noncustodial parents who are in arrears on child support payments. (Michigan takes this option.)

Mandating Transitional Benefits:

The League supports the House bill’s requirement that all states provide five months of transitional SNAP benefits to families that leave TANF cash assistance without requiring them to reapply or submit additional paperwork. (This is currently a state option. Michigan does not take this option because all cash assistance recipients are categorically eligible for SNAP and most continue to receive SNAP after leaving cash assistance.)

Increasing Earned Income Deduction:

The League supports the House bill’s increase of the earned income deduction (used to calculate benefits) from 20% to 22% of earnings, which gives a modest benefit increase to households with earnings.

*Although the name of the program was changed from the Food Stamp Program to the Supplemental Nutrition Assistance Program nearly ten years ago, some politicians continue to use the former name, perhaps due to its pejorative connotations.

]]>http://www.mlpp.org/lets-talk-sense-about-snap-the-house-bill-would-burden-families-and-states-with-unnecessary-paperwork/feed0http://www.mlpp.org/lets-talk-sense-about-snap-the-house-bill-would-burden-families-and-states-with-unnecessary-paperworkWhy policy matters – even to those seemingly outside of its reachhttp://feedproxy.google.com/~r/FactuallySpeaking/~3/1G4jMxfeVJY/why-policy-matters-even-to-those-seemingly-outside-of-its-reach
http://www.mlpp.org/why-policy-matters-even-to-those-seemingly-outside-of-its-reach#respondWed, 16 May 2018 13:59:52 +0000http://www.mlpp.org/?p=44208

Charlotte Jonkman

My name is Charlotte Jonkman and I am one of the new interns here at the League. Introductions have never been easy for me – primarily because my path to this point in life has been relatively uneventful. I grew up in Jenison, Michigan with my parents and two older brothers, along with my entire extended family less than a half hour’s drive away. I attended private school from preschool through high school and chose to continue that path, enrolling in Baylor University where I am now one semester away from receiving my bachelor’s degree in Political Science. Though the term “boring” often comes to mind when I reflect on the past 20 years, I have come to appreciate that “privileged” might serve as a more apt descriptor.

Recognition of that privilege served as the catalyst for my interest in public policy. I still remember a 10th grade teacher asking the class how often our lives interacted with the government. Some students cited their trips to the DMV to receive their driver’s licenses or the tax forms they’d filed due to recently-acquired first jobs—encounters that occur annually, at most. The majority of us were surprised when our teacher went on to explain how government impacts our lives at every turn, from the electricity powering the classroom lights to the clean water flowing from nearby drinking fountains to the (unrelentingly pothole-filled) roads we’d driven to school.

Looking back now, I know that we were lucky to be surprised. Children attending underfunded schools or relying on government assistance to put food on their plates feel the presence of public policy in their lives far more than I ever did. That realization–that the world is a whole lot bigger and more complex than my little corner of West Michigan—drove me to become more engaged in the news and, from there, to desire a better understanding of the policies everyone seemed to have such strong opinion about.

Since then, my initial interest has grown into a passion for utilizing the daily interaction between citizens and government to improve the lives of those who cannot claim the privilege of a mundane childhood. Specifically, I am passionate about providing economic opportunity through the protection of labor rights and the expansion of access to healthcare. In these policy areas and others, I have learned a lot over the past few years. Through my university classes, I have gained knowledge in political history and the workings of government. I continue to expand my understanding of public policy through independent reading and, admittedly, countless hours spent listening to political and historical podcasts. Unfortunately, my ever-growing Netflix queue will have to wait until “Slow Burn” has taught me all there is to know about Watergate and the New York Times’ “The Daily” has updated me on the news of the day.

While, like most people, the mere mention of annual budget negotiations or subcommittee meetings does not necessarily get my blood pumping, the benefit that seemingly miniscule changes in public policies might bring to thousands of lives drives me to continue learning and growing and is what led me to the League. I am extremely grateful for the opportunity to be part of an organization that shares my focus on the human impact of public policy and works to make that impact a positive one. And I am excited to spend the summer learning from and working with the many committed and passionate individuals here at the League.

Last week, the Michigan League for Public Policy staff took a “field trip” to the Museum of African American History in Detroit. It was an amazing afternoon filled with knowledge sharing, delicious food and deep conversations about history and culture. Since this was my first time visiting this museum (and many of you probably haven’t been), I would like to bring you along. Here are some of the lessons and experiences I won’t forget.

You may write me down in history
With your bitter, twisted lies,
You may trod me in the very dirt
But still, like dust, I’ll rise.

— Maya Angelou, “Still I Rise”

The Charles H. Wright Museum of African American History is one of the largest museums of its kind in the world. When you step into its lobby, you immediately sense that you are somewhere special. A large, domed ceiling illuminates a beautiful mural in the center of the room, encircled by the names of the trailblazers who made the museum possible. I find Rosa Parks, Malcolm X and Martin Luther King, Jr. alongside dozens of names I don’t recognize. From the very beginning of our tour, I know I have a lot to learn.

The Still We Rise exhibition, named after Maya Angelou’s famous “Still I Rise” poem, explains the history of African colonization, the slave trade, American slavery, the civil rights movement, and more. Our brilliant tour guide, Yolanda, gives us rich and haunting explanations of what it would have been like to be plucked from home, put in chains, and hauled to a new continent to be sold into slavery.

At one point in the tour, we descend into the belly of a slave ship, where hundreds of men and women are packed into bunks. They are chained so close to one another that they cannot move without jostling their neighbors. They are starved, and many have grown ill from sea travel and the unsanitary conditions of the ship itself.

When faced with the actual, physical conditions of enslavement and slavery, I wonder how anyone survived it. It is miraculous not only that people survived generations of enslavement, but that they found ways to disrupt political, social and economic systems in order to demand equality. The sheer strength of will and heart contained within African American history in this country is staggering.

I believe every person living in the U.S. has a responsibility to learn about African American history, especially considering our society’s enduring struggles with institutional racism. Be sure to visit the museum if you are able, and if not, I hope you will find ways to learn about African American history. Check out a book from your local library, watch a Netflix documentary, talk with your friends and neighbors… We learn little in school, and too many of us choose to live in peaceful ignorance of our history. We can do better.

The sun cast a warm glow over the colorful little stores lining both sides of 26th Street in Little Village—the commercial hub of the historically Mexican neighborhood in Chicago. I sat on a packed bus of advocates touring Chicago’s historic communities of color as part of a workshop at Equity Summit.

Attendees of the tour of Chicago’s historical communities of color stopped by the Bronzefille Incubator; an organization that supports local entrepreneurs in the historically black community of Bronzefille.

Home to thousands of immigrants and families of color, Little Village also happens to be home to the largest single-site jail in America, our guide informed us. Flanked by four cement walls, Cook County Jail stood as a constant, ominous warning to residents in the community. A short distance from the jail sits a new community park—the product of years of community advocacy for green spaces in the neighborhood. The glaring contrast of the jail and the park is obvious to anyone who visits the community, but the park serves as an example of the ability to make something beautiful and liberating in a space of oppression.

Despite being on the receiving end of decades of systematic racism and neglect, Little Village and Chicago’s other historic communities of color—like Bronzeville and Chinatown—are resilient thanks to community members who have found innovative ways to revitalize local economies and slow the encroachment of gentrification. That afternoon, the tour of Chicago’s historic communities of color set the tone for my week at Policy Link’s Equity Summit. I walked away from the workshop understanding that in order to build a truly intersectional movement for justice, advocates need to recognize and confront racism in our communities and our policies, and have a willingness to work in solidarity with one another to achieve justice.

As Policy Link’s CEO, Angela Glover Blackwell phrased it in her opening plenary speech, “solidarity is hard.” It is a difficult thing to create and maintain. But in order to succeed in achieving an equitable society, we must transcend our silos and self-interest and show up for one another in movements for justice. That week, 4,000 advocates from across the country came together and tried to do just that. We heard one another, learned from one another and strategized together.

Victoria Crouse go to catch up with friends and fellow attendees working on policy issues in different states at the Summit.

The conference sessions were organized around different areas of equity work in communities. I attended sessions on the topics of inclusive gender justice, intersectional immigration reform, and criminal justice, among others. In each session, I listened to the voices of those closest to the pain: community activists, returning citizens, and undocumented immigrants. I listened to them recount stories about triumphs and losses, as well as lessons learned in the field. Each time, I left energized to do the work in Michigan.

Edna Chavez speaking at the March for Our Lives in Washington D. C., on March 24th. Source: Huffington Post

One of the conference highlights for me was getting to hear Edna Chavez share about a recent policy win for students in California. Chavez is a community organizer and high school senior from South Los Angeles, who advocates for gun reform in her state. Last month, a video of Chavez recounting the horrors of gun violence in her community at the March for Our Lives in Washington D.C., went viral. Her words resonated with thousands of people across the country. During her Q & A session with Angela Glover Blackwell, Chavez shared an example of the power of youth activism. She shared about how students and community activists in South LA had recently succeeded in securing the implementation of the Student Equity Need Index in the Los Angeles Unified School District. The index will ensure that the district allocates approximately $300 million in supplemental funding to the schools who need it the most. Her words reminded all of us in the audience that as we do this work, we must trust young people because they are directly impacted by policymakers’ decisions, and they are already leading the movement.

Have you ever read a bill in its entirety? If you have, congratulations, that can be quite a task. If not, let me explain a bit what it’s like. Bills can be complex. They can be long. They can have all sorts of details and clauses included, but have all the meat confined to one small section that makes all the difference. In a nutshell, there are times when a bill can appear to be written in a foreign language, traversed only by lawyers, bureaucrats, and politicians.

But understanding bills, and thereby understanding the policies they aim to enact, is essential. While you may never see a hard copy of a bill, or hear much about what’s going on in the State House or Senate, what they pass or don’t pass ultimately impacts each one of us. It could be changes to Medicaid, the state income tax, or teacher pensions; regardless of what the topic is, in some way, somehow, the effects of various policy decisions will sift down to every individual. It is because of this inevitability, and the stake that each individual has in their society, that comprehension of policy is so important.

Now, most people are busy. Jobs, friends, kids, school … there are a million and one things going on in our lives that keep us moving, keep us working, keep us focused or even distracted. For the majority of us, policy is not one of those things. Luckily for society, there are a select few who have managed to make the interpretation of policy, and then the relaying of information to others in a direct and familiar fashion, their livelihoods. Such people can be found working at the Michigan League for Public Policy.

My own understanding of policy at the beginning of this year was limited. While I had kept up to date on the major legislative debates in Congress, I hadn’t ever done real research into the depths of any piece of policy. From day one with the League though, I was surrounded by professionals. Working here are the types of people who one would consider “policy wonks”. Here are the number crunchers, the data collectors, and the graph creators. The work that happens in this office day in and day out is painstaking, long, at times extremely frustrating, but done entirely with real passion and purpose. Through all that they do, the people at the League are dedicated advocates, policy experts motivated to promote equity and fairness, especially for those who have received the short end of the stick more often than not.

You can imagine that working with individuals of this caliber, I picked up on a few things. And while it is true that I now am more confident in discussing, researching, debating and writing about healthcare and taxes, perhaps more valuable was that through this process I have started to define why good policy is important to me. Policy is a reflection of society. The values of a people are exposed via the policies which they favor. Effective and equitable policy must then be a constantly sought, which requires that policies be backed up by facts and logic, and shaped with a vision towards a more just society. While I still have much to learn about both policy and my own value-based judgements, my experience with the League has put me on the right path.

I leave here having gained a great deal. The people I have met, and lessons I have learned will propel me towards future goals and help me with future endeavors. I have thoroughly enjoyed my time here, from the endless rounds of edits Rachel had me working on, to witnessing Tillie magically transform my excel graphs into something worth looking at, and smack talking this dreary Michigan winter with anyone and everyone who strolled by my desk. To all the staff here, and my fellow intern Alexa, it has been a pleasure. I wish the best to you all, and again, thanks to you all for making this an experience by which I have learned a truly substantial amount.

As a legislator I took seriously my duty to serve the people I represented. I made it a priority to stay informed, to read the latest data and reports on each issue, and to ask experts for their opinions. But one of the most important aspects of my work was to listen. My constituents were not just data points. They were people. It was my job to hear their voices, and I’ve carried that priority with me to the League.

Unfortunately, listening to constituents and making informed decisions appears to be a lost art in the Legislature. Two weeks ago, the Michigan Senate passedSenate Bill 897, a proposal to take away Medicaid and the Healthy Michigan Plan from folks who don’t work a stringent number of hours. OnMay 2, I testified in opposition to this bill in the House Appropriations Committee, but they may take it up for a vote any day now.Please help stop it.

Ralph H. is self-employed and works from home because he needs to care for his wife, who is disabled. For 10 years, Ralph went without health insurance, as many self-employed people do. When he was approved for the Healthy Michigan Plan, Ralph was finally able to get surgery for a blood clot. Since being on the plan, he still lacks stable income, but at least he hasn’t been worried about his basic healthcare needs. “Some months, we’re lucky if we have $100 left over, once we pay all our bills, so we’re hardly running away with the state’s money.”

He’s nervous because due to the lack of information and clarity on the bill, he’s not sure he can continue to receive healthcare. “Without the coverage, I would essentially be thrown back into the situation that I confronted before I finally got it. That’s one more worry that I certainly do without.”

Kristen H. (no relation) shared a cautionary story with us. She lost her job—and insurance coverage—when her daughter was diagnosed with a genetic syndrome and required more care than Kristen could manage while working. It’s every parent’s nightmare. Kristen, a single mom, found herself suddenly unemployed, with no insurance, and caring for three kids, including a child facing major health issues. “The next several years were very difficult financially as I wasn’t able to work, but we managed to get by. I ended up having a minor surgery during that time that could have seriously impacted my health. Without Medicaid, I may have put off getting care, resulting in serious harm. I may not have been here to provide care not only for my disabled daughter, but my other two children as well. It not only could have impacted my health, but I could have ended up in a financial hole I couldn’t get out of as well.”

Because of Medicaid, Kristen was able to care for her daughter and eventually she was able to work again. But she’s terrified for other parents who might find themselves in her situation: “I would have been one of the individuals who may not be here today if these requirements were in place when my family so desperately needed the safety net that Medicaid provided.”

Therese O. is a 54-year-old widow who receives Medicaid. She couldn’t afford insurance payments after her husband died, and she now works from home. Her work, though, doesn’t offer healthcare and she doesn’t earn enough to purchase it on her own. “This proposal to make Medicaid recipients work 29 hours per week will cause me to lose my Medicaid. If I could work that much, I wouldn’t need Medicaid. I am housebound and I have no family to help me.”

Mitch and Julie B. are married and both self-employed. While Mitch is a veteran and has health insurance through Veterans Affairs, he wrote that “the only way we can afford healthcare for my wife is with Medicaid.” They are worried about how self-employed people will prove their work hours. But they have another concern—homeschooling their daughter. As Julie shared, “Between the two of us we work 60+ hours a week so that one of us can be with our child. Why should one of us have to get a low-paying job so that we can put her in school, pay for childcare and afterschool care?”

These are just some of the stories we’ve heard. Other potential concerns include people who work seasonal jobs or people in the service industry with unpredictable work hours, and those with mental health challenges. People like Ralph, Kristen, Therese, Mitch and Julie, and others need to know they can continue receiving healthcare. They are already living in perilous situations, uncertain from week to week whether they’ll be able to afford the basics. We’re terribly concerned that some in the Legislature seem to be ignoring stories like these and are instead insisting on cutting people off.

Stable healthcare allows people to work. Taking away healthcare just creates yet another barrier to holding down a job to support one’s family. These requirements would be a great burden to patients, hospitals, employers and state offices. The question I’m wondering is, “Other than the perceived health of some candidates’ campaigns, who is this poorly conceived policy really helping?”

I have had the incredible experience of interning with the Michigan League for Public Policy during this never-ending winter. The people I have met, and the knowledge and heartbreak (from researching student homelessness) I have experienced, provided me with immense opportunity to reflect on my personal life and be grateful for what I have. Working at the League has enabled me to research topics I had never really thought of before, providing me the opportunity to find my passion—advocating for those less fortunate than I am.

Education has always been something extremely important to me and I will forever be grateful to my parents for supporting me and granting me with the opportunity to receive the education that I have. Last summer I had an internship with a nongovernmental organization (NGO) that focused on providing support to youth in the Middle East and North Africa (MENA region) to help them find employment. Upon starting at the League I had the opportunity to pick what I wanted to focus on, so naturally, I picked something closely related to education—student homelessness. These two internships have allowed me to gain a better appreciation for what I have and drove me to further shape my future goals to help students that have not had the same opportunities I have had.

Collaborating with the big-hearted individuals at the League and the incredibly passionate people I have met throughout the past four months has contributed to the development of my long-term goal to start a nonprofit to advocate for students in Michigan to receive the best education they can, while having a stable environment to thrive in. Life is not all about academic education, but also about what is learned outside of the classroom, through work, sports, clubs or whatever else students may be involved in. Learning should not just be confined to a classroom, although the classroom plays a big part in the overall structure, there is so much opportunity out there to learn and grow as individuals. Often times people look at the bigger picture of how we can help, and focus their resources abroad or nationally, but it is extremely important to understand that so much can be done much closer to home.

During my time at the League, I have worked on the 2018 Kids Count in Michigan Data Book to help determine that the economic, health, education, and family and community sectors in the state of Michigan still have a long way to grow. To better the national standards, we must first start by bettering the standards in Michigan.

Thank you to everyone at the League for the huge hearts you have for advocating for the people of Michigan and for accepting me into your family. Special thanks to Alicia Guevara Warren, my incredible boss, for providing me with this amazing opportunity to grow and learn so much about the disparities in Michigan. There was never a day that I didn’t look forward to coming to the office to see what problem was being tackled that day. Thank you to Rachel, Gilda, my fellow intern Spike, and everyone else at the League for providing such a fun, hardworking environment to advocate for change. I’m so thankful for the opportunity to intern with the League this semester. I will never forget all of the things I have been able to accomplish with the help, advice and guidance of the advocates at the League!

We at the League make no secret of the fact that we celebrate what tax dollars can do for our state. Schools, parks, bridges, safety services, roads and other important community resources are funded by taxes, so we certainly had plenty of reasons to cheer for taxpayers on April 17 (and April 18) and every day of the year. Among these taxpayers are thousands of undocumented Michiganders who filed their tax returns just as they do every year. As we celebrate all the good things taxes provide, we also honor our immigrant neighbors and community members whose invaluable contributions to Michigan’s culture and economy have helped revive our state in more ways than one.

Current rhetoric on immigration often overlooks the important contributions undocumented immigrants make to our communities as neighbors, workers and taxpayers. Research from the Institute on Taxation and Economic Policy highlights the significant contributions that undocumented immigrants make to our state and local economies by paying taxes. According to the report, undocumented immigrants across the United States collectively contribute $11.74 billion in state and local taxes. In the Great Lakes state, which is home to more than half a million foreign-born residents, about 130,000 undocumented immigrant residents contributed an estimated $86.6 million in state and local taxes in 2014 (the latest year for which data is available).

What are some of the ways undocumented Michiganders contribute to the tax base, you ask? Just like their fellow residents, undocumented Michiganders pay sales and excise taxes on things such as utilities, clothing and gasoline. They also pay property taxes, either directly on their homes or indirectly as renters. Furthermore, undocumented immigrants also pay state income taxes that help grow state investments in schools, infrastructure, healthcare and other important services.

Among residents who help strengthen our state are Dreamers—young undocumented immigrants whose futures continue to hang in the balance as Congress stalls action on the Dream Act. Dreamers contribute to our communities every single day, and they also contribute to our local and state economies as working professionals, consumers and entrepreneurs. As taxpayers, they contributed an estimated $13 million in Michigan in 2014. Yet, if Dreamers lose their DACA status, they will also lose their temporary work permits that enable them to work in good-paying jobs with benefits. The loss in tax revenue from this shift is equivalent to the cost of 220 teacher salaries in Michigan.1

Looking at the contributions of our immigrant neighbors in Michigan brings up an important question about fairness. Michigan’s tax system is upside down—it’s regressive. This means that Michiganders who have low and middle incomes pay a larger portion of their income in taxes than the top 20% of taxpayers. Unfortunately, undocumented taxpayers aren’t left out of this unbalanced system. When it comes to state and local taxes, the average effective tax rate (a measure of the share of total income paid in taxes) for undocumented immigrants is 8%, and 8.9% for Dreamers (young undocumented immigrants). This is striking when compared to the average nationwide effective tax rate among the richest taxpayers: 5.4%.

Policymakers can and must make wise choices that strengthen our communities and recognize the substantial contributions made by our immigrant neighbors. When it comes to immigration, state and national leaders have an opportunity to explore and enact sound public policies that promote economic growth and immigrant integration based on facts and reality rather than playing out the politics of fear and division.